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MD Incentive Compensation
Alexa B. Kimball, MD, MPHMedical Director, Mass General Physicians Organization
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MGH 1811 Corporation
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Massachusetts General Physicians Organization (MGPO)Organization and History
Formed in 1994 from 3 existing MGH physician groups.
Governed by a Board of Trustees, half of whom are lay members.
Includes 2,700+ physicians with clinical appointments, almost all of whom are employed by the MGPO.
Formed in 1994 from 3 existing MGH physician groups.
Governed by a Board of Trustees, half of whom are lay members.
Includes 2,700+ physicians with clinical appointments, almost all of whom are employed by the MGPO.
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Compensation History
Compensation plans rolled out across departments over past 10 years; most have a productivity component
Quality Incentive Program introduced in 2006 2 Terms per year/3 measures per term
Departments also may have some incentive based plans
Internal Performance Framework introduced as we moved increasingly into risk contract
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Physician Compensation & IncentivesChallenges
Change • Reducing the relative
compensation for clinical productivity to fund other incentives (population management, quality, management of TME, etc.), without reducing professionalism, morale, sense of autonomy/mastery, work ethic.
Danger of “Monetization” • Protecting the commitment to
education and academics.
Physician perception• The independent contractor• The cog in the machine
(neither is ideal)
Low HighRelevance of Incentive to
Individual Physician
Easy
Hard
Abil
ity
to M
easu
re
MGPO
Department
Center
Unit / Practice
Individual Doctor
Department
QI program
IPF
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Overall. 18th program term, 1,940 eligible clinicians
Performance by measure. Population health management: 99% met the target Joint Commission training: 98% met the target Department measures: 29 measures, 91% of MDs met
their target
Communication. Results in a personal email, online, and in the June
Fruit Street Physician Payment is in the June paycheck
QI HighlightsResults for Term 1, 2015
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*This chart may overstate results for small groups.
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Internal Performance Framework
Forcefield effect Strategy Trend Quality
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Not done yet: Taskforce Recommended Principles 2014
General: Improve clinical care or contribute to mission Consistent with an ethical framework of practice for physicians
Compensation Comp plan structures should be transparent, consistent and
fair Chiefs should have some discretion over comp components Comp plans should be adjustable over time to market forces
and support recruitment and retention Productivity measures
Productivity incentives should be included in most compensation plans
Non-productivity measures Measurable Actionable Adjustable
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Recommended Implementation Principles
Incentives should be integrated in a manner that… Improve patient care Minimizes administrative burden Leverages MGPO QI program admin structure Recognizes and supports diversity in
compensation plans across and within departments
Ideally adds at-risk compensation while preserving current pay
Maintains compensation levels to recruit and retain world-class physicians
Creates opportunity to phase out historical metrics that may be outmoded